<#include "/client/config.ftl"/>
<!DOCTYPE html>
<html>

	<head>
		<meta charset="utf-8">
		<meta name="viewport" content="width=device-width, initial-scale=1,maximum-scale=1, user-scalable=no" />
		<title></title>
		<link rel="stylesheet" href="${base}/css/bootstrap.min.css" />
		<link rel="stylesheet" href="${base}/css/common.css" />
		<script type="text/javascript" src="${base}/js/jquery-1.12.0.min.js"></script>
		<script type="text/javascript" src="${base}/js/bootstrap.2.0.min.js"></script>
		<script type="text/javascript" src="${base}/js/jquery.bootstrap.wizard.js"></script>

	</head>

	<body>
		<div class="container-fluid">
			<div id="rootwizard">
				<div class="navbar hidden_area">
					<div class="navbar-inner">
						<div class="container">
							<ul>
								<li><a href="#tab1" data-toggle="tab"></a></li>
								<li><a href="#tab2" data-toggle="tab"></a></li>
								<li><a href="#tab3" data-toggle="tab"></a></li>
								<li><a href="#tab4" data-toggle="tab"></a></li>
								<li><a href="#tab5" data-toggle="tab"></a></li>
								<li><a href="#tab6" data-toggle="tab"></a></li>
								<li><a href="#tab7" data-toggle="tab"></a></li>
								<li><a href="#tab8" data-toggle="tab"></a></li>
							</ul>
						</div>
					</div>
				</div>
				<form action="${base}/client/task/addHealth" id="form" method="post">
					<div class="tab-content">
						<div class="tab-pane" id="tab1">
							<ul>
								<li class="list_each">
									<h1>1、您从事一些费力的活有苦难吗？比如提很重的物品。</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
								<li class="list_each">
									<h1>2、长距离行走对您来说有困难吗？</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
								<li class="list_each">
									<h1>3、户外短距离行走对您来说有困难吗？</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
								<li class="list_each">
									<h1>4、您白天需要呆在床上或者椅子上吗？</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
								<li class="list_each">
									<h1>5、您在穿衣、吃饭、洗澡需要他人帮忙吗？</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
							</ul>
						</div>
						<div class="tab-pane" id="tab2">
							<h2>在过去一星期内：</h2>
							<ul>
								<li class="list_each">
									<h1>6、您在工作日或者日常活动中是否收到限制？</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
								<li class="list_each">
									<h1>7、您在从事您的爱好和日常休闲活动中是否有受到限制？</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
								<li class="list_each">
									<h1>8、您有气短吗？</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
								<li class="list_each">
									<h1>9、您有疼痛吗？</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
							</ul>
						</div>
						<div class="tab-pane" id="tab3">
							<h2>在过去一星期内：</h2>
							<ul>
								<li class="list_each">
									<h1>10、您需要休息吗？</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
								<li class="list_each">
									<h1>11、您睡眠有苦难吗？</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
								<li class="list_each">
									<h1>12、您觉得虚弱吗？</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
								<li class="list_each">
									<h1>13、您食欲不振（没有胃口）吗？</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
							</ul>
						</div>
						<div class="tab-pane" id="tab4">
							<h2>在过去一星期内：</h2>
							<ul>
								<li class="list_each">
									<h1>14、您觉得恶心吗？</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
								<li class="list_each">
									<h1>15、您有呕吐吗？</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
								<li class="list_each">
									<h1>16、您有便秘吗？</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
								<li class="list_each">
									<h1>17、您有腹泻吗？</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
							</ul>
						</div>
						<div class="tab-pane" id="tab5">
							<h2>在过去一星期内：</h2>
							<ul>
								<li class="list_each">
									<h1>18、您觉得累吗？</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
								<li class="list_each">
									<h1>19、疼痛影响您的日常活动吗？</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
								<li class="list_each">
									<h1>20、您集中精力做事有困难吗，比如看报或者看电视？</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
								<li class="list_each">
									<h1>21、您觉得紧张吗？</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
							</ul>
						</div>
						<div class="tab-pane" id="tab6">
							<h2>在过去一星期内：</h2>
							<ul>
								<li class="list_each">
									<h1>22、您觉得忧虑吗？</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
								<li class="list_each">
									<h1>23、您觉得脾气暴躁吗？</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
								<li class="list_each">
									<h1>24、您觉得压抑（情绪低落）吗？</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
								<li class="list_each">
									<h1>25、您感到记忆困难吗？</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
							</ul>
						</div>
						<div class="tab-pane" id="tab7">
							<h2>在过去一星期内：</h2>
							<ul>
								<li class="list_each">
									<h1>26、您的身体状况或者治疗影响您的家庭生活吗？</h1>
									<div class="page_right">
										<select class="form-control" class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
								<li class="list_each">
									<h1>27、您的身体状况或者治疗影响您的社交活动吗？</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
								<li class="list_each">
									<h1>28、您的身体状况或者治疗使您陷入经济困难吗？</h1>
									<div class="page_right">
										<select class="form-control" name="tiValue">
											<option value="1">没有</option>
											<option value="2">有点</option>
											<option value="3">相当</option>
											<option value="4">困难</option>
										</select>
									</div>
								</li>
							</ul>
						</div>
						<div class="tab-pane" id="tab8">
							<h2>对于一下问题，请您在1-7中选择一个最适合您的数字：</h2>
							<ul>
								<li class="list_each">
									<h1>29、您如何评价在过去一星期内您总的健康情况？</h1>
									<div class="page_right">
										<img class="img_sty" src="${base}/image/hl-level.png"/>
										<select class="form-control sel_sty" name="tiValue">
											<option value="1">1</option>
											<option value="2">2</option>
											<option value="3">3</option>
											<option value="4">4</option>
											<option value="5">5</option>
											<option value="6">6</option>
											<option value="7">7</option>
										</select>
									</div>
								</li>
								<li class="list_each">
									<h1>30、您如何评价在过去一星期内您总的生命质量？</h1>
									<div class="page_right">
										<img class="img_sty" src="${base}/image/hl-level.png"/>
										<select class="form-control sel_sty" name="tiValue">
											<option value="1">1</option>
											<option value="2">2</option>
											<option value="3">3</option>
											<option value="4">4</option>
											<option value="5">5</option>
											<option value="6">6</option>
											<option value="7">7</option>
										</select>
									</div>
								</li>
							</ul>
						</div>
						<ul class="pager wizard">
							<div class="hidden_area">
								<input type="hidden" name="tsId" value="${task.tsId}">
							</div>
							<li class="previous"><a href="#">上一步</a></li>
							<li class="next"><a href="#">下一步</a></li>
							<li class="next finish" style="display:none;"><a href="javascript:;">确认</a></li>
						</ul>
					</div>
				</form>
			</div>
		</div>

		<script>
			$(document).ready(function() {
				$('#rootwizard').bootstrapWizard({
					onTabShow: function(tab, navigation, index) {
						var $total = navigation.find('li').length;
						var $current = index + 1;
						// If it's the last tab then hide the last button and show the finish instead
						if ($current >= $total) {
							$('#rootwizard').find('.pager .next').hide();
							$('#rootwizard').find('.pager .finish').show();
							$('#rootwizard').find('.pager .finish').removeClass('disabled');
						} else {
							$('#rootwizard').find('.pager .next').show();
							$('#rootwizard').find('.pager .finish').hide();
						}
					}
				});
				$('#rootwizard .finish').click(function() {
					$("#form").submit();
				});
			});
		</script>

	</body>

</html>